Multiplying Laborers for the Urban Harvest

A p p e n d i x

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Site Finalization Form Please complete the following form in its entirety and return to The Urban Ministry Institute. This fulfills the final requirement for your church or ministry to become a Satellite of The Urban Ministry Institute. We look forward to resourcing you as you continue to train and equip laborers for the urban harvest! 1. I have enclosed payment in the amount of $1,500 for our Satellite Site License Fee (see Appendix 7). This payment is in the form of a:  Check/Money Order (circle one)  Visa/MasterCard/Discover (circle one) Card number: _______ - _______ - _______ - _______ Expiration date: ______________

Name on card: ________________________________ Billing address: ________________________________ ________________________________ 3-digit verification code from back of card: ____________

2. The names and addresses of our Advisory Board are as follows (see page 36):

Name

Address

3. The name of our Institute is (see page 41):

4. Our Mission Statement is (see page 41; Appendix 8):

P a g e

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